Under the mammary gland? In a semi-muscular area? Where should the breast implant be placed?

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In terms of anatomical location, breast implants can be placed in several different positions within the body, and the advantages and disadvantages of each position are analyzed below.
In my experience with outpatient consultations, patients often ask questions like: "Doctor, do breast implants always have to be placed under the muscle? Can they be placed somewhere between the muscle and the muscular tissue?" and "I want the results to be natural and undetectable after surgery; where would be the best place to put them?"
Before we begin, we can refer to the diagram below to understand the relative positions of the chest tissue and muscle tissue.

In terms of anatomical location, breast implants can be placed in several different positions within the body, and the advantages and disadvantages of each position are analyzed below.

  • Subglandular

The implant is placed behind the breast tissue. The results of the breast augmentation surgery are obvious, but if bleeding and other issues are not properly controlled during the surgery, problems such as touching the capsule or the implant may occur.

  • Breast augmentation implants placed subfascially.

The implant is placed under the pectoralis major fascia. The postoperative effect is obvious, but the fascia on the lower inner side becomes very thin, which can easily lead to incomplete soft tissue coverage on the inner side, meaning the implant can be felt.

  • Breast implants placed under the muscle (submuscular)

The implant is placed under the pectoralis major muscle. Traditionally, the implant can achieve full soft tissue coverage through the pectoralis major muscle. The disadvantage is that women who exercise or dance regularly may find that the implant shifts during certain movements, mainly because the implant adheres to the pectoralis major muscle.

The above three types of plane classifications seem to each have their own advantages and disadvantages. Is there a plane that can simultaneously achieve obvious breast augmentation, sufficient soft tissue coverage, and avoid postoperative implant displacement, that is, an ideal plane?
  • Dual plane

This is what is commonly referred to as the "half-muscle, half-flesh" plane. John B. Tabbets mentioned in a 2001 article that in breast augmentation surgery, "by opening part or all of the connection between the pectoralis major muscle and the sternum, the implant can be placed simultaneously under both the muscle and soft tissue, thereby changing the relative position of the implant and the breast tissue." Placing the implant under these two planes can lift the breast tissue, provide complete soft tissue coverage, and prevent the implant from shifting due to muscle movement.

Will this surgical design guarantee a flawless outcome? Experience shows that women in China generally have thinner skin and less breast tissue. After a dual-plane surgical design, insufficient soft tissue coverage at the lower edge and outer sides may occasionally occur. In such cases, modifying the dual-plane design before surgery to increase coverage of the pectoralis major muscle tissue at the lower edge is a possible solution.

 

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